By David W. Hilgers, Brown McCarroll, L.L.P., Austin, TX
I have just returned from the most successful Emerging Issues Conference (EMI) in our Section’s history—successful from all perspectives. First, it was, of course, an outstanding CLE experience. It started on Wednesday morning with the Breast Cancer Legal Advocacy training session. At that meeting, experts spoke to over 40 participants regarding the many obstacles that face the victims of breast cancer. This program, and the others like it that we do throughout the country, have trained dozens of lawyers in this important area of legal advocacy. Wednesday afternoon was devoted to the fundamentals of healthcare, with almost 90 attendees having the opportunity to learn about the basic fundamentals of health care from the experts. On Thursday, the conference opened with a timely initial session discussing fraud and abuse enforcement from the point of view of the federal enforcers.
The Pending 21.2 Percent Reduction in Medicare Physician Fee Schedule Payments
By Christopher J. Kutner, Esq. and Jennifer C. Koehler, Esq., Farrell Fritz, P.C., Uniondale, New York
In its Medicare Physician Fee Schedule (MPFS) for calendar year 2010, the Centers for Medicare and Medicaid Services (CMS) implemented a 21.2 percent reduction in the Medicare physician fee conversion factor, resulting in a blanket reduction in physician fee schedule payments under Medicare Part B. The impact of this reduction cannot be understated, as Medicare is the largest payer for health services in the United States. On December 21, 2009, President Obama signed the Department of Defense Appropriations Act for 2010, which included a short-term delay for the looming reduction until March 1, 2010. Subsequently, when the reduction took effect, Congress passed a thirty day extension on this delay. How future events unfold may significantly impact the Medicare physician reimbursement system.
MLR: The Controversial Calculation Makes Its Appearance In The Health Care Reform Debate
By Wendy J. Stein, Law Office of Wendy J. Stein, P.A., Hollywood, Florida
Three letters of the alphabet have caused a whirlwind of legislative activity in 32 states and were the subject of a Congressional investigation, complete with former health insurance executive testimony. They are now a major battleground in the current health care reform debate in Washington. Those letters are MLR which stand for Medical Loss Ratio, the proportion of health care insurance premium dollars spent on health care claims. Uses of MLR by health insurance companies include (1) evaluation of an organization’s performance by management and investors; (2) providing consumers with information on the relative quality of competing health plans; (3) projecting future earnings growth of HMOs; (4) testing products against minimum loss standards; and (5) solvency regulation.
Will the Mental Health Parity and Addiction Equity Act of 2008 Successfully Encourage Employers to Provide Benefits for Inpatient Mental Health Treatment?
By John T. Seybert, Esq. and Edward Stumpp, Esq., Sedgwick, Detert, Moran & Arnold, LLP
For more than four decades, lawmakers have struggled to enact laws requiring employee benefit plans to provide mental health treatment benefits to participants subject to the same terms, conditions and limitations as the medical treatment benefits afforded under the same health benefit plan. Most attempts at reaching this goal have failed to achieve such parity, particularly with respect to inpatient mental health treatment. The question addressed in this article is whether the enactment of The Mental Health Parity And Addiction Equity Act of 2008 (“MHPAEA”) effective October 3, 2009 and the interim rules released on February 2, 2010, effective April 5, 2010, will finally achieve such parity.
HITECH Business Associates Task Force:
Waiting for the Other Shoe to Drop
By John R. Christiansen, Christiansen IT Law, Seattle, Washington
Chair, ABA Health Law Section HITECH Task Force
The February 17 compliance date for most Business Associate requirements under HITECH has come and gone, and we are still waiting for regulatory guidance. The unofficial word is that we probably should anticipate a notice of proposed rule making (NPRM), and perhaps some enforcement leniency for violations which aren’t too egregious. But we still don’t know when to expect anything to be published, or how lenient enforcement might be. So what’s a lawyer to do?
Did you know membership in an interest group is FREE with your Health Law Section membership?
Did you know your membership in the ABA Health Law Section qualifies you for free membership in up to three interest groups of your choice? Interest groups, which are comprised of twelve practices areas within health law, make significant contributions to the Section's programming, publications and legislative initiatives. The interest groups also provide an excellent opportunity for you to interact with and have access to some of the most outstanding lawyers in the legal community. You can enroll on our webpage by clicking here. If you have any questions or need more information, please contact Simeon Carson at Simeon.Carson@americanbar.org.
Managed Care & Insurance Interest Group
The Managed Care & Insurance Interest Group focuses on such issues as federal and state regulation of HMOs and other managed care organizations.
The IG is led by Chair Michelle Apodaca, Texas Hospital Association, Austin, TX and Vice-Chairs Denise Glass, Fulbright & Jaworski LLP, Dallas, TX; Leigh Anne Hodge, Balch & Bingham LLP, Birmingham, AL; Alice King, ESI, Dallas, TX and Fred A. Smith III, Sedgwick, Detert, Moran & Arnold, Chicago, IL.
If you would like to join the Interest Group, continue by clicking the following link: Health Law Section IG Sign-up Form.
ABA eSource Editorial Board
The ABA Health eSource Editorial Board is led by Chair Lisa Genecov, Locke Lord Bissell and Liddell LLP, Dallas, TX and editorial board members Michael E. Clark, Duane Morris LLP, Houston, TX; Adrienne Dresevic, The Health Law Partners, PC, Southfield, MI; Marla Durben Hirsch, Potomac, MD and Conrad Meyer, Chaffe McCall, LLP, New Orleans, LA.
Do you want to communicate your ideas to thousands of other members? To contribute a newsletter article on a health law topic, send us your ideas to Simeon.Carson@americanbar.org
|The opinions expressed are those of the authors and shall not be construed to represent the policies or positions of the ABA or the ABA Health Law Section. |
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